Community EMT proposal must protect public (Page 58)

Dealing with discharged patients continues to be one of the most confounding problems with hospital care. Nurses often don’t have the time to give patients all the education they need when they leave the hospital. The result: many go home confused, unable to care for themselves, and unsure how to get better.

Rep. Tara Mack (R- Apple Valley) Community EMT bill (HF261) enables EMTs to visit discharged patients the day after they get home, but the bill doesn’t actually specify what CEMTs can and can’t do.   The result could be agencies that allow CEMTs’ work to infringe on what nurses are specifically trained and prepared to do.

“Anybody can take vital signs but it’s what you do with that information that’s dependent on your training,” said Stacy Enger, an ER nurse at Methodist Hospital, “As a nurse, I’m trained and licensed to assess, intervene, and most importantly, re-assess patients.”

Enger testified at the House Health and Human Services Policy Committee hearing on the bill that she’s seen the effects of firefighters, EMTs, and paramedics who visit discharged patients already. Agencies in the west Metro, including Edina, St. Louis Park, and Eden Prairie have already begun the CEMT program with the help of Methodist.

“Edina and Burnsville use volunteer firefighters and there’s a clear difference in what we learn about a patient coming in with those departments versus one who comes in from a paramedic from North Memorial, Allina, or HCMC,” Enger said.

The Chief Nursing Officer at Methodist, who testified for the bill, confirmed that they still get many questions on the hospital nurse triage line even with the program.   The bill also has the support of the Professional Fire Fighters Association, which claims that 80 percent of their firefighters’ work is now healthcare.

MNA Nursing Policy Specialist, Mat Keller, pointed to the many problems that still exist in the legal language of the bill. He noted that the language allows CEMTs can do anything to intervene that prevents emergency department caring for the patient.   He said that could include anything from administering IVs to delivering a baby.

“It is important to remember that an EMT certification requires only 120 hours of training,” said Keller, a nurse and an attorney, “this equates to about half of one college semester. Furthermore, those 120 hours are dedicated to teaching EMTs the things they need to know in order to fulfill their role, which is to operate in emergency situations.”

Even proponents of the bill admit that CEMTs would probably only spend 15-20 minutes with a patient during their visit, which doesn’t allow for a proper assessment.

“Let’s say I’ve come to see you, and one thing I do is get you up and help you walk around,” Enger said, “one of the first things I’m looking for is if you are a fall risk. Can you get around? Are there things in your way that you might trip over or hit with a walker or crutches? We call it a “road test.” Sometimes, you road test somebody and you realize that the house needs to be de-cluttered or maybe rails or supports need to be installed somewhere. Sometimes, you road test somebody and they’re very quickly out of breath. We have to figure out if it’s because you are or have been a smoker. Or maybe it’s because you’ve gotten a hospital-acquired infection, which might turn into a fatal pneumonia?”

Rep. Erin Murphy (DFL-St. Paul), an RN, mentioned her time caring for patients at the bedside and in the home setting. Murphy urged “more work “ on the bill to delineate tasks and eliminate any infringement on the scope of practice.

Rep. Mack admitted that another issue to be worked on is which Minnesota board will oversee CEMTs. The bill names the Emergency Medical Services Board, but, as Keller noted, these actions would only be non-emergency situations.

HF261 was passed over for possible inclusion in the final Health and Human Services bill. MNA will continue to visit the Capitol with nurses to work with legislators on making the bill something that can truly benefit the patients of Minnesota.